Culture, Health and Illness

An Introduction for Health Professionals

Cecil Helman

• Publisher: Butterworth-Heinemann
• Year: 2013
• Print ISBN:
  9780723607038
• eBook ISBN:
  9781483193472
• Topic: Social Sciences
• Subtopic: Cultural & Social Anthropology
• Index: Social Sciences

Culture, Health and Illness: An Introduction for Health Professionals covers basic ideas and research in medical anthropology. The book starts by discussing the scope of medical anthropology and the cultural definitions of anatomy and physiology, including the body structure and its functions. The text describes the clinical significance of food in diet and nutrition, social and cultural aspects of medical pluralism and health care. Doctor-patient interactions; social, psychological and cultural factors associated with pain; and non-pharmacological influences of medication, in relation to placebos, psychotropic and narcotic drugs, alcohol, and tobacco are also considered. The book then covers the type of rituals that relate to health and illness and the management of misfortune. The text also encompasses transcultural psychiatry, the cultural aspects of stress, and cultural factors in epidemiology. The selection is useful to health professions (doctors, nurses, midwives, health visitors, medical social workers, and nutritionists); those involved in health education or foreign medical aid; undergraduate students taking up these disciplines; and those studying anthropology or sociology.

CHAPTER 1

Introduction: The Scope of Medical Anthropology

Publisher Summary

Medical anthropology is about how people in different cultures and social groups explain the causes of ill-health, the types of treatment they believe in, and to whom they turn if they do get ill. It is also the study of how these beliefs and practices relate to biological changes in the human organism, in both health and disease. Anthropology, as a field of study, has several branches. Physical anthropology also known as human biology is the study of the evolution of the human species. Material culture deals with art and artifacts of mankind, both in the present and the past. Social and cultural anthropology deal with the comparative study of present-day human societies and their cultural systems, though there is a difference in emphasis between these two approaches. In studying society and culture, anthropologists have used two main approaches, namely, the ethnographic approach, which involves the study of small-scale societies or of relatively small groups of people to understand how they view the world and organize their daily lives. Ethnography leads to the second approach, the comparative approach, which seeks to distil out the key features of each society and culture and to compare these with other societies and cultures to draw conclusions about the universal nature of man and his social groupings. Though medical anthropology is a branch of social and cultural anthropology, its concern is also with a wide range of biological phenomena, especially in connection with health and disease.

Medical anthropology is about how people in different cultures and social groups explain the causes of ill-health, the types of treatment they believe in, and to whom they turn if they do get ill. It is also the study of how these beliefs and practices relate to biological changes in the human organism, in both health and disease.

To put this subject in perspective, it is necessary to know something about the discipline of anthropology itself, of which medical anthropology is a comparatively new offshoot. Anthropology—from the Greek, meaning ‘the study of Man’—has been called ‘the most scientific of the humanities and the most humane of the sciences’.¹ Its aim is nothing less than the holistic study of mankind—including its origins, development, social and political organizations, religions, languages, art and artefacts.

Anthropology, as a field of study, has several branches. Physical anthropology—also known as ‘human biology’—is the study of the evolution of the human species, and is concerned with explaining the causes for the present diversity of human populations. In its investigation of human pre-history it utilizes the techniques of archaeology, palaeontology, genetics and serology, as well as the study of primate behaviour and ecology. Material culture deals with art and artefacts of mankind, both in the present and the past. It includes studies of the arts, musical instruments, weapons, clothes, tools and agricultural implements of different populations, and all other aspects of the technology which human beings use to control, shape, exploit and enhance their social or natural environments. Social and cultural anthropology deal with the comparative study of present-day human societies, and their cultural systems, though there is a difference in emphasis between these two approaches.

In Britain, social anthropology is the dominant approach, and emphasizes the social dimensions of human life. Man is a social animal, organized into groups that regulate and perpetuate themselves, and it is man’s experience as a member of society which shapes his view of the world. In this perspective, culture is seen as one of the ways that man organizes and legitimizes his society, and provides the basis for its social, political and economic organization. In the United States, cultural anthropology focuses more on the systems of symbols, ideas and meanings that comprise a culture, and of which social organization is just an expression. In practice, the differences in emphasis of social and cultural anthropology provide valuable and complementary perspectives on two central issues—the ways that human groups organize themselves, and the ways that they view the world that they inhabit. In other words, when studying a group of human beings, it is necessary to study the features of both their society and their culture.

Keesing² has defined a society as: ‘A population marked by relative separation from surrounding populations and a distinctive culture.’ The boundaries between societies are sometimes vague, but in general each has its own territorial and political identity. In studying any society, anthropologists investigate the ways that members of that society organize themselves into various groups, hierarchies and roles. This organization is revealed in its political, economic and religious systems, in the types of bonds that kinship or close residence creates between people, and in the division of labour between different people. The rules that underpin the organization, and the ways that it is symbolized and transmitted, are all part of that society’s culture.

What then is culture?—a word that will be used on many occasions throughout this book. Anthropologists have provided many definitions of it, perhaps the most famous being E. B. Tylor’s³ definition, in 1871: ‘That complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society’. Keesing⁴, in his definition, stresses the ideational aspect of culture. That is, cultures comprise: ‘Systems of shared ideas, systems of concepts and rules and meanings that underlie and are expressed in the ways that humans live’.

From these definitions one can see that culture is a set of guidelines (both explicit and implicit) which an individual inherits as a member of a particular society, and which tells him how to view the world, and how to behave in it in relation to other people, to supernatural forces or gods, and to the natural environment. It also provides him with a way of transmitting these guidelines to the next generation—by the use of symbols, language, art and ritual. To some extent, culture can be seen as an inherited ‘lens’, through which the individual perceives and understands the world that he inhabits, and learns how to live within it. Growing up within each society is a form of enculturation, whereby the individual slowly acquires the cultural ‘lens’ of that society.

Anthropologists such as Leach⁵ have pointed out that virtually all societies have more than one culture within their borders. For example, most societies have some form of social stratification, into social classes, castes or ranks, and each stratum is marked by its own distinctive cultural attributes, including linguistic usages, manners, styles of dress, dietary and housing patterns, and so on. Rich and poor, powerful and powerless—each will have their own inherited cultural perspective. In addition to such social strata, one can see that most modern complex societies, such as Britain or the United States, include within them religious and ethnic minorities, tourists, foreign students, political refugees, recent immigrants, and migrant workers—each with their own distinctive culture. Many of these groups will undergo some degree of acculturation, whereby they incorporate some of the cultural attributes of the larger society. A further subdivision of culture within a complex society is seen in the various professional sub-cultures that exist, such as the medical, legal or military professions. In each case, they form a group apart with their own concepts, rules and social organization. While each subculture is developed from the larger culture, and shares many of its concepts and values, it also has unique, distinctive features of its own. Students in these professions also undergo a form of enculturation, as they slowly acquire the ‘culture’ of their chosen career. In doing so, they also acquire a different perspective on life from those who are outside the profession. In the case of the medical profession this might interfere with doctor-patient communication, as illustrated in Chapter 5, and in other parts of this book.

In studying society and culture anthropologists have used two main approaches: the ethnographic approach, which involves the study of small-scale societies, or of relatively small groups of people, in order to understand how they view the world, and organize their daily lives. The aim is to discover—in so far as this is possible—the ‘actor’s perspective’; that is, to see how the world looks from the perspective of a member of that society. To discover this, anthropologists often carry out fieldwork, using the ‘participant observation’ technique, whereby they live with and observe a group of people, and learn to see the world through their eyes, while at the same time retaining the objective perspective of the social scientist. Ethnography leads to the second approach, the comparative approach, which seeks to distil out the key features of each society and culture, and to compare these with other societies and cultures, in order to draw conclusions about the universal nature of man, and his social groupings.

In its earlier years, anthropology was mainly concerned with studies of small-scale tribal societies within, or at the borders of, the colonial empires. Modern anthropology, however, is just as concerned with doing ethnographies in complex, Western societies. The ‘tribe’ of a modern anthropologist might easily be a sect in New York, a suburb in London, a group of doctors in Los Angeles, or patients attending a clinic in Michigan. In all these cases, though, both the ethnographic and comparative approaches are used—as well as some of the interviewing and measurement techniques of sociology or psychology.

Although medical anthropology is a branch of social and cultural anthropology, its concern is also with a wide range of biological phenomena, especially in connection with health and disease. As a subject it therefore lies—sometimes uncomfortably—in the overlap between the social and the natural sciences, and draws its insights from both sets of disciplines. In Foster and Anderson’s⁶ definition it is: ‘A biocultural discipline concerned with both the biological and sociocultural aspects of human behaviour, and particularly with the ways in which the two interact and have interacted throughout human history to influence health and disease’.

Anthropologists studying the socio-cultural end of this spectrum have pointed out that in all human societies beliefs and practices relating to ill-health are a central feature of the culture. Often these are linked to beliefs about the origin of a much wider range of misfortune (including accidents, inter-personal conflicts, natural disasters, crop failures, and theft or loss), of which ill-health is only one form. In some of these societies, the whole range of these misfortunes is blamed on supernatural forces, or on divine retribution, or on the malevolence of a ‘witch’ or ‘sorcerer’. The values and customs associated with ill-health are part of the wider culture, and cannot really be studied in isolation from it. One cannot really understand how people react to illness, death or other misfortune without an understanding of the type of culture that they have grown up in, or acquired—that is, of the ‘lens’ through which they are perceiving and interpreting their world. In addition to the study of culture, it is also necessary to examine the social organization of health and illness in that society—which includes the ways that people become recognized as ‘ill’, the ways that they present this illness to other people, and the attributes of those they present their illness to. This latter group—or ‘healers’—are found in different forms in every human society. Anthropologists are particularly interested in the characteristics of this special social group—their selection, training, concepts, values and internal organization. They also study the way that these people fit into the social system as a whole—their rank in the social hierarchy, their economic or political power, and the division of labour between them and other members of the society. In some human groups the healers play roles beyond their healing functions—they may act as ‘integrators’ of the society, who regularly reassert the society’s values (see Chapter 8)—or as agents of social control, helping to label and punish socially deviant behaviour (see Chapter 9). It is therefore important, when studying how individuals in a particular society perceive and react to ill-health, and the types of health care that they turn to, to know something about both the cultural and the social attributes of the society in which they live. This is one of the main tasks of medical anthropology.

At the biological end of the spectrum, medical anthropology draws on the techniques and findings of medical science, and its various sub-fields—including microbiology, biochemi...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Acknowledgements
• Chapter 1: Introduction: The Scope of Medical Anthropology
• Chapter 2: Cultural Definitions of Anatomy and Physiology
• Chapter 3: Diet and Nutrition
• Chapter 4: Caring and Curing
• Chapter 5: Doctor—Patient Interactions
• Chapter 6: Pain and Culture
• Chapter 7: Culture and Pharmacology
• Chapter 8: Ritual and the Management of Misfortune
• Chapter 9: Transcultural Psychiatry
• Chapter 10: Cultural Aspects of Stress
• Chapter 11: Cultural Factors in Epidemiology
• Clinical Questionnaires
• References
• Index